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OFFICE OF THE ALPINE COUNTY CLERK COUNTY CLERK FILING STAMP PO Box 158 99 Water Street Markleeville CA 96120 FILING FEE: $15.00 FOR FIRST BUSINESS NAME ON STATEMENT $4.00 FOR EACH ADDITIONAL BUSINESS NAME OR OWNER IN EXCESS OF ONE A MAIL FILED DOCUMENTS TO: NAME ADDRESS CITY/ST/ZIP DAYTIME PHONE ( ) B First Filing Renewal Filing With Changes C PUBLISH IN TAHOE DAILY TRIBUNE NEWSPAPER: Ph.: [PHONE REDACTED] Current Registration No. FICTITIOUS BUSINESS NAME STATEMENT THE FOLLOWING PERSON(S) IS (ARE) DOING BUSINESS AS: (Please Print or Type) * Fictitious Business Name(s) 3. 1. 2. Articles of Incorporation or Organization Number (if applicable) Street Address, City & State of Principal Place of Business in California Zip Code Full name of Registrant (if corporation or limited liability company-show state of incorporation or organization) Residence Street Address City State Zip Code Full name of Registrant (if corporation or limited liability company-show state of incorporation or organization) Residence Street Address City State Zip Code Full name of Registrant (if corporation or limited liability company-show state of incorporation or organization) Residence Street Address City State Zip Code This Business is An Individual Joint Venture A Limited Partnership An Unincorporated Association Conducted by Married Couple A Corporation A General Partnership than a Partnership (check only one) Copartners A Business Trust A Limited Liability Company Registered Domestic Partner The registrant commenced to transact business under the fictitious name or names listed above on (Date): _ If you have not yet commenced business, write "Not applicable.” I DECLARE THAT ALL INFORMATION IN THIS STATEMENT IS TRUE AND CORRECT. A REGISTRANT WHO DECLARES AS TRUE ANY MATERIAL MATTER PURSUANT TO THIS SECTION THAT THE REGISTRANT KNOWS TO BE FALSE IS GUILTY OF A MISDEMEANOR PUNISHABLE BY A FINE NOT TO EXCEED ONE THOUSAND DOLLARS ($1,000). Signature of Registrant Printed Name and Title This statement was filed with the County Clerk of Alpine County on (date indicated by file stamp above). I HEREBY CERTIFY THAT THIS COPY IS A CORRECT COPY OF THE ORIGINAL STATEMENT ON FILE IN MY OFFICE Howard, Alpine County BY DEPUTY File No. SEE REVERSE SIDE FOR INSTRUCTIONS Rev. 1/1/2014 NOTICE IN ACCORDANCE WITH SUBDIVISION OF SECTION 17920, A FICTITIOUS NAME STATEMENT GENERALLY EXPIRES AT THE END OF FIVE YEARS FROM THE DATE ON WHICH IT WAS FILED IN THE OFFICE OF THE COUNTY CLERK, EXCEPT, AS PROVIDED IN SUBDIVISION OF SECTION 17920, WHERE IT EXPIRES 40 DAYS AFTER ANY CHANGE IN THE FACTS SET FORTH IN THE STATEMENT PURSUANT TO SECTION 17913 OTHER THAN A CHANGE IN THE RESIDENCE ADDRESS OF A REGISTERED OWNER. A NEW FICTITIOUS BUSINESS NAME STATEMENT MUST BE FILED BEFORE THE EXPIRATION THE FILING OF THIS STATEMENT DOES NOT OF ITSELF AUTHORIZE THE USE IN THIS STATE OF A FICTITIOUS BUSINESS NAME IN VIOLATION OF THE RIGHTS OF ANOTHER UNDER FEDERAL, STATE, OR COMMON LAW (SEE SECTION 14411 ET SEQ., BUSINESS AND PROFESSIONS CODE). ---PAGE BREAK--- INSTRUCTIONS FOR COMPLETION OF STATEMENT TYPE OR CAREFULLY PRINT IN INK (PENCIL NOT ACCEPTABLE) BUSINESS AND PROFESSIONS CODE SECTION 17913: Box A. Insert the name and address of the person who you want to receive the certified copy. Box B. If this is a new business please check the box marked First Filing. If you are refilling, please check the box marked Renewal Filing and enter your current registration number. If any changes in names, address, etc., check box With Changes. Box C. Newspaper designated for publishing. * Where one asterisk appears in the form: Insert the fictitious business name or names Only those businesses operated at the same address and under the same ownership may be listed on one statement Where two asterisks appear in the form: If the registrant has a place of business in this state, insert the street address and county of his or her principal place of business in this state If the registrant has no place of business in this state, insert the street address and county of his or her principal place of business outside this state and file with the Clerk of Alpine County (B&P 17915) Mail Box and Post Office Box Numbers are not acceptable as a business address when used alone without a street address Where three asterisks appear in the form: If the registrant is an individual, insert his or her full name and residence address If the registrants are a married couple, insert the full name and residence address of both parties to the marriage If the registrant is a general partnership, co-partnership, joint venture, limited liability partnership, or unincorporated association other than a partnership, insert the full name and residence address of each general partner If the registrant is a limited partnership, insert the full name and residence address of each general partner If the registrant is a limited liability company, insert the name and address of the limited liability company, as set out in its articles of organization on file with the CA Secretary of State, and the state of organization If the registrant is a trust, insert the full name and residence address of each trustee If the registrant is a corporation, insert the name and address of the corporation, as set out in its articles of incorporation on file with the CA Secretary of State, and the state of incorporation If the registrants are state or local registered domestic partners, insert the full name and residence address of each domestic partner ****Where four asterisks appear in the form: Check whichever of the terms listed on the front of the form best describes the nature of the business *****Where five asterisks appear in the form: Insert the date on which the registrant first commenced to transact business under the fictitious business name or names listed, if already transacting business under that name or names Insert N/A if you have not yet commenced to transact business under the fictitious business name or names listed BUSINESS AND PROFESSIONS CODE SECTION 17914 The statement shall be signed as follows: If the registrant is an individual, by the individual If the registrants are a married couple, by either party to the marriage If the registrant is a general partnership, limited partnership, limited liability partnership, co-partnership, joint venture, or unincorporated association other than a partnership, by a general partner If the registrant is a limited liability company, by a manager or officer If the registrant is a trust, by a trustee If the registrant is a corporation, by an officer If the registrant is a state or local registered domestic partnership, by one of the domestic partners BUSINESS AND PROFESSIONS CODE SECTION 17915 The fictitious business name statement shall be filed with the clerk of the county in which the registrant has his or her principal place of business in this state or, if the registrant has no place of business in this state, with the Clerk of Alpine County. Nothing in this chapter shall preclude a person from filing a fictitious business name statement in a county other than that where the principal place of business is located, as long as the requirements of this subdivision are also met. BUSINESS AND PROFESSIONS CODE SECTION 17917 Publication for Original, New Filings (renewal with change in facts from previous filing), or refile Within 30 days after a fictitious business name statement has been filed, the registrant shall cause it to be published in a newspaper of general circulation in the county where the fictitious business name statement was filed or, if there is no such newspaper in that county, in a newspaper of general circulation in an adjoining county. If the registrant does not have a place of business in this state, the notice shall be published in a newspaper of general circulation in Alpine County. The publication must be once a week for four successive weeks and an affidavit of publication must be filed with the county clerk where the fictitious business name statement was filed within 30 days after the completion of the publication. If a refiling is required because the prior statement has expired, the refiling need not be published, unless there has been a change in the information required in the expired statement, provided the refiling is filed within 40 days of the date the statement expired. BUSINESS AND PROFESSIONS CODE SECTION 17922 Abandonment of Fictitious Business Name Upon ceasing to transact business in this state under a fictitious business name that was filed in the previous five years, a person who has filed a fictitious business name statement shall file a statement of abandonment of use of fictitious business name. The statement shall be executed and published in the same manner as a fictitious business name statement and shall be filed with the county clerk of the county in which the person has filed his or her fictitious business name statement. BUSINESS AND PROFESSIONS CODE SECTION 17930 Any person who executes, files, or publishes any statement under this chapter, knowing that such statement is false, in whole or in part, shall be guilty of a misdemeanor and upon conviction thereof shall be punished by a fine not to exceed one thousand dollars ($1,000).